Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service, a new medical information system

Soo Lim, Seon Mee Kang, Hayley Shin, Hak Jong Lee, Ji Won Yoon, Sung Hoon Yu, S. O.Youn Kim, Soo Young Yoo, Hye Seung Jung, Kyong Soo Park, Jun Oh Ryu, Hak C. Jang

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OBJECTIVE - To improve quality and efficiency of care for elderly patients with type 2 diabetes, we introduced elderly-friendly strategies to the clinical decision support system (CDSS)-based ubiquitous healthcare (u-healthcare) service, which is an individualized health management system using advanced medical information technology. RESEARCH DESIGN AND METHODS - We conducted a 6-month randomized, controlled clinical trial involving 144 patients aged >60 years. Participants were randomly assigned to receive routine care (control, n = 48), to the self-monitored blood glucose (SMBG, n = 47) group, or to the u-healthcare group (n = 49). The primary end point was the proportion of patients achieving A1C <7% without hypoglycemia at 6 months. U-healthcare system refers to an individualized medical service in which medical instructions are given through the patient's mobile phone. Patients receive a glucometer with a public switched telephone network-connected cradle that automatically transfers test results to a hospital-based server.Once the data are transferred to the server, an automated system, the CDSS rule engine, generates and sends patient-specific messages by mobile phone. RESULTS - After 6 months of follow-up, the mean A1C level was significantly decreased from 7.8 ±1.3% to 7.4 ± 1.0% (P< 0.001) in the u-healthcare group and from 7.9 ±1.0% to 7.7 ± 1.0%(P = 0.020) in the SMBG group, compared with 7.9±0.8% to 7.861.0% (P=0.274) in the control group. The proportion of patients with A1C <7% without hypoglycemia was 30.6% in the u-healthcare group, 23.4% in the SMBG group (23.4%), and 14.0%in the control group (P< 0.05). CONCLUSIONS - The CDSS-based u-healthcare service achieved better glycemic control with less hypoglycemia than SMBG and routine care and may provide effective and safe diabetes management in the elderly diabetic patients.

Original languageEnglish
Pages (from-to)308-313
Number of pages6
JournalDiabetes Care
Issue number2
StatePublished - 1 Feb 2011

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